鞍底带蒂粘膜骨瓣复位联合带蒂粘膜瓣进行鞍底重建在垂体腺瘤术中的应用

目的 探讨鞍底带蒂粘膜骨瓣复位联合鼻中隔粘膜瓣进行鞍底重建在垂体腺瘤经鼻蝶入路神经内镜切除术中的应用效果。方法 回顾性分析2016年3月至2021年11月经鼻蝶入路神经内镜手术治疗的36例垂体腺瘤的临床资料，术中应用鞍底带蒂粘膜骨瓣复位联合鼻中隔粘膜瓣重建鞍底。结果 36例完成鞍底带蒂粘膜骨瓣制作、复位，其中10例切除肿瘤过程中鞍隔破裂，术中出现脑脊液漏，结合鼻中隔粘膜瓣完成鞍底重建。肿瘤全切除31例，次全切除5例；肿瘤全切除率为86.1%(31/36)。术后无脑脊液鼻漏、颅内感染。术后随访3～12个月，无鞍底粘膜骨瓣移位，无迟发性脑脊液鼻漏、颅内感染。结论 鞍底带蒂粘膜骨瓣复位联合鼻中隔粘膜瓣重建鞍底，方法简单，可有效预防垂体腺瘤经鼻蝶入路神经内镜切除术后脑脊液漏。

Application of sellar floor reconstruction using sellar floor pedicled mucosal bone flap combined with nasal septal mucosal flap to transnasal endoscopic resection for pituitary adenomas

Objective To introduce a method of sellar floor reconstruction using sellar floor pedicled mucosal bone flap and nasal septal mucosal flap during transnasal endoscopic resection of pituitary adenomas. Methods The clinical data of 36 patients with pituitary adenoma who underwent transnasal endoscopic resection from March 2016 to November 2021 were analyzed retrospectively. During the operation, the sellar floor pedicled mucosal bone flap and nasal septal mucosal flap were used to reconstruct the sellar floor. Results The sellar floor pedicled mucosal bone flaps were anatomically reduced in all the patients. Cerebrospinal fluid leakage occurred in 10 patients during the operation. Total tumor resection was achieved in 31 patients and subtotal in 5. The total tumor resection rate was 86.1% (31/36). There was no cerebrospinal fluid rhinorrhea and intracranial infection after the operation. The follow-up (range, 3~12 months) showed no displacement of the saddle base mucosal bone flap, and no delayed cerebrospinal fluid rhinorrhea and intracranial infection. Conclusions It is a simple method to reconstruct the sellar floor using the sellar floor pedicled mucosal bone flap and nasal septal mucosal flap, which can effectively prevent cerebrospinal fluid leakage after transnasal neuroendoscopic resection for pituitary adenomas.